Bats in the Belfry 2005

Bats in the Belfry: : 

Bats in the Belfry: Coordinating a Response to a Possible Rabies Exposure in the High School Setting Presented by: Michael Kennedy, MGA, MPH, CHES Malyn Pratt, RN, BSN, NCSN

case scenario for a possible rabies exposure in the school setting ? : 

case scenario for a possible rabies exposure in the school setting ? Student body drawn from all parts of large county Dozens of classes, multiple buildings First week of school Problem discovered by public health officials on Friday afternoon after students have been dismissed Magnet middle/high school of the arts, grades 6 - 12 worst What is the

What is that smell ?? : 

What is that smell ?? Recent renovations sealed up bat openings in roof areas of one of the school buildings Bats unable to exit the building at night Attempted escape through air vents, loose ceiling tiles

Which way is out ? : 

Which way is out ? Throughout the week, bats continue to attempt escape at night, sleep during the day Sleeping upside down Attached to ceilings in classrooms, bathrooms, stairwells Under desks

Student Response : 

Student Response Pick up sleeping bats, place in boxes or trashcans Attempt to release them outdoors Chase them, pick them up Take them home for pets

School Staff Response : 

School Staff Response Administrators notified Critter Control to remove the remaining bats over the weekend Teachers attempted to knock them down with brooms and directed students to release them outside Some teachers used them for science classes No one called either the Health Department or the School Nurse!

Why is Rabies a Public Health Issue ? : 

Why is Rabies a Public Health Issue ? Endemic in wild mammals, especially bats, skunks, foxes, raccoons Always fatal once symptoms are present Rabies virus is present in animal saliva and nervous tissue of infected animals Spread when they bite or scratch May be spread by inhaling bat saliva

What should be done in the event of possible exposure ? : 

What should be done in the event of possible exposure ? Wash exposed area with soap and water for at least ten minutes Call healthcare provider and local health department immediately Call animal control to find and catch animal for rabies testing Begin post exposure prophylaxis with Rabies Immune Globulin and rabies vaccine

How did the Health Departmentfind out ? : 

How did the Health Departmentfind out ? Friday afternoon, the School Nurse saw students releasing bats, notified LHD School staff reported that bats had been in the building all week

Public Health Response : 

Public Health Response Medical, Health Directors notified Medical Director notified Superintendent of Schools Plans made for investigation to begin Monday morning Incomplete discussion with school principal Media was alerted to inform the community

Course of Investigation : 

Course of Investigation CD staff begins screening interviews with all identified students, school staff Confusion regarding privacy issues 8 bats sent to state lab for testing Letters signed by Medical Director sent to all school staff, parents Student education regarding rabies, treatment and potential consequences of exposure

Interview Challenges : 

Interview Challenges Problems with wording: did you touch a bat? Incomplete student rosters Logistical difficulties to ensure all were interviewed Rumor mill The adolescent mind: fear of shots but no fear of death

Interview Procedure : 

Interview Procedure Screening interview by CD or School Nurse Second comprehensive interview by CD Specialist for those with contact

Results of Investigation : 

Results of Investigation 1400 students and staff interviewed 1000 students and staff admitted to seeing or having contact with bats 160 students had second comprehensive interviews Eight students were referred for rabies post exposure prophylaxis. Three of these initially denied touching bats. Three students were lost to follow up. One student left the state with no forwarding address. Two had incomplete contact information.

What did we learn ? : 

What did we learn ? The importance of planning that involves all stakeholders, including education on the risk of rabies and privacy issues during a public health emergency The importance of communication between the school system and the health department Kids will lie to avoid getting shots

Positive Outcomes : 

Positive Outcomes All 8 bats tested for rabies were negative Once all stakeholders were informed, they worked together - a learning experience for all The school community and the larger community received education about the danger of rabies in the wild animal population The relationship between the school system and the health department improved The role of public health and school health was clarified for the community

Questions? : 

Questions? Thank you ! Free at last !